Obstructive sleep apnea (OSA)

What is obstructive sleep apnea?

Paediatric obstructive sleep apnea (OSA), or sleep apnea, happens when a child's airway repeatedly becomes partially or completely closed or blocked while they are sleeping. The blockage of the airway can cause snoring, gasping, pauses in breathing and changes in the body's oxygen levels.

Sleep apnea affects 1 to 5 children in 100. Some children snore but do not have OSA.

Nighttime symptoms of obstructive sleep apnea

If your child has obstructive sleep apnea, you will recognize several signs while you watch them sleep. These may include:

• snoring — this may be continuous or with pauses or may only occur in certain body positions (for example while your child lies flat on their back) or during certain periods of sleep
• breathing only through the mouth
• restless sleep
• long pauses in breathing
• frequently waking up at night
• sweating

When your child is experiencing restless sleep, they may be turning from side to side, jerking their legs or sitting up to breathe better while still asleep.

Daytime symptoms of obstructive sleep apnea

Because your child is waking up many times during the night, they are not rested in the morning. As a result, they may have the following symptoms during the day:

• sleepiness, especially at school or during quiet activities
• learning difficulties
• poor concentration for homework
• lack of energy for sports and hobbies
• irritability, hyperactivity, impulsivity or aggression.

What causes obstructive sleep apnea?

Common causes of obstructive sleep apnea in children are larger than normal tonsils or enlarged adenoids at the back of the nasal passages (the airways behind the nose). Obstructive sleep apnea due to enlarged tonsils or adenoids commonly occurs in children aged two to eight years.

Other possible causes of obstructive sleep apnea include:

• a child being overweight or obese
• weakness in the muscles involved in breathing, such as the diaphragm and muscles in the neck and around the ribs, such as in a neuromuscular disease (a disease that affects the nerves and muscles)
• the shape and size of a child's skull and jaw
• other health conditions that affect your child's airways or ability to breathe.

Tonsils and adenoids

How is sleep apnea diagnosed in children?

Your child's health-care provider will usually refer them to a sleep medicine specialist in the hospital. The sleep medicine specialist will meet with you to see if your child's symptoms need a closer look. If so, your child will come back to the hospital for a sleep study.

This study is an overnight sleep "test" during which your child will have wires attached to their skin with paste and child-friendly tape. The wires do not hurt and are connected to a machine. As your child sleeps, the machine will record their oxygen level, breathing pattern, heartbeat and sleep pattern. A sleep technologist will also observe your child during the study.

Once the sleep study is over, a sleep medicine specialist will study the recordings on the machine to identify the type of sleep problem your child has and how serious it is.

How is obstructive sleep apnea treated?

Obstructive sleep apnea can be treated with:

• surgery to remove your child's tonsils and/or adenoids
• a weight loss program if your child is overweight or obese
• medicines to reduce swelling in the nasal passage or airway
• continuous positive airway pressure therapy (commonly known as CPAP)
• reduced exposure to second-hand tobacco smoke and other indoor and outdoor forms of pollution

If your child has other medical conditions that may affect or be affected by obstructive sleep apnea, the sleep medicine team may refer them to other specialists and clinics to make sure they get the best treatment.

Why is it important to diagnose and treat obstructive sleep apnea?

It is important to diagnose obstructive sleep apnea early. If it is not treated, it can be linked to other health issues, such as:

• cardiovascular complications, including high blood pressure
• not growing well or gaining weight
• learning difficulties at school
• behavioural problems such as hyperactivity or inattention.

At SickKids

The sleep medicine team at SickKids includes:

• a respirologist — a doctor specially trained to diagnose and manage sleep disorders in children
• a nurse practitioner
• a respiratory therapist
• a sleep technologist
• a child life specialist

Other members of the health care team, such as a social worker or a psychiatrist, may provide specialized care when needed.